1225461221 NPI number — ALYSON NICOLOSI APRN

Table of content: ALYSON NICOLOSI APRN (NPI 1225461221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225461221 NPI number — ALYSON NICOLOSI APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICOLOSI
Provider First Name:
ALYSON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADLER
Provider Other First Name:
ALYSON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225461221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 PHOENIX AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06702-1418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-756-8021
Provider Business Mailing Address Fax Number:
203-596-9038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 PHOENIX AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06702-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-756-8021
Provider Business Practice Location Address Fax Number:
203-596-9038
Provider Enumeration Date:
08/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  005452 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008046690 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225461221 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 223160873 . This is a "HEALTHYCT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 223160873 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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